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Thoracic aortic transection

Case contributed by Michael P Hartung
Diagnosis certain

Presentation

Low velocity MVC, hit chest on steering wheel.

Patient Data

Gender: Female

Presentation

x-ray

Widened mediastinum.

Left apical cap. 

ct

Small left pneumothorax with chest tube. Small right effusion. 

Hemomediastinum. 

Transection of the thoracic aorta near the isthmus with large pseudoaneurysm. 

Case Discussion

Devastating injury which was not initially suspected as this patient was in a low-velocity MVC with few complaints of pain. 

The tethering of the ligamentum arteriosum creates a point of relative fixation, and the patient likely had a deceleration/shearing injury occur in the isthmus, resulting in transection/rupture. 

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